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South Dakota rates for HCPCS 20902

Bone Graft Any Donor Area Major/Large

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.54 / $268.54 / $268.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.20 / $510.03 / $1,065.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.93 / $814.35 / $8,250.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.62 / $480.41 / $611.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$105.52 / $105.52 / $105.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$105.52 / $105.52 / $105.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00